ProMax Lipo Client Declaration

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To be completed by client no later than 24 hours before first treatment

Email *

First and last name *

Client telephone number *

Today's date *

YYYY

Please read the consent notices below and tick each box to indicate that you understand and accept the information contained herein and that which has been explained to you verbally in your consultation. *

The information I have given is correct to the best of my knowledge, and I have not withheld any known medical state or condition. I will inform the operator before treatment if there has been any change (for example, medications taken).

I understand that the results from this treatment vary considerably and a small percentage of people may not respond satisfactorily to treatment.

I understand multiple treatments are necessary to achieve optimal results.

I understand that there is no guarantee of permanent results and maintenance treatments are often required.

I understand that there may be short-term side effects such as bruising, reddening, swelling and rarely mild burning or blistering. To date there have been no reports of any permanent scarring or discoloration but thi cannot be ruled out completely.

I understand that any pre-paid treatment package is non-transferable and non-refundable and valid for 12 months from date of deposit payment.

I certify that I have read and understood all the information and my questions have been answered satisfactorily before submitting this consent form. I consent to the terms of this agreement and by pressing the submit button I am legally agreeing to these terms.

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